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Peripheral Vascular Disease Flashcards

1
Q

There are how many types of blood vessels?

A

5

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2
Q

What are the types of blood vessels?

A

Veins
Venules
Capillaries
Arteries
Arterioles

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3
Q

Blood vessels that carry deoxygenated blood, Thin, less muscular wall

A

Veins/ venules

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4
Q

Blood vessel with 3 less defined layers

A

Veins/ venules

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5
Q

Blood vessels that distend more than arteries

A

Veins/ venules

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6
Q

Blood vessels with valves to prevent backward flow

A

Veins/ venules

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7
Q

75% total blood volume is in the

A

veins

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8
Q

SNS can stimulate constriction of these blood vessels

A

veins

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9
Q

These blood vessels use contraction of skeletal muscles to move blood flow

A

Veins/ venules

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10
Q

Single layer blood vessels with thin walls that permits transport

A

Capillaries

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11
Q

Blood vessels where oxygen and CO2 exchange

A

Capillaries

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12
Q

Blood vessels that carry oxygen rich blood

A

Arteries/Arterioles

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13
Q

Blood vessels with thick walls and three distinct layers

A

Arteries/Arterioles

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14
Q

The inner layers of the arteries/ arterioles are

A

smooth

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15
Q

The middle layer of the arteries/ arterioles

A

dilates/constricts

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16
Q

The outer layer of the arteries/ arterioles

A

Anchor vessels

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17
Q

Blood vessels where chemical, hormonal, neuronal factors effect constriction and dilation

A

Arteries/Arterioles

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18
Q

The lymphatic system collects lymph from tissues and organs and transports into

A

venous circulation

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19
Q

Permeable to large molecules ie: protein

A

lymph

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20
Q

Muscular contraction of walls and tissue propels lymph towards

A

venous drainage

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21
Q

Excess fluid from the arterial-venous filtration is absorbed by

A

lymphatic circulation

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22
Q

Runs alongside the capillary bed

A

lymphatic system

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23
Q

Hardening of arteries

A

Arteriosclerosis

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24
Q

Plaque formation

A

Atherosclerosis

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25
Q

Injury to endothelium causes platelets and monocytes

A

to aggregate

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26
Q

Two types of lesions

A

Fatty streaks
fibrous plaques

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27
Q

Decreased flow of oxygen rich blood due to narrowed arterial lumen is caused by

A

Arteriosclerosis and atherosclerosis

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28
Q

Increased metabolic demands caused by arteriosclerosis and atherosclerosis leads to

A

ischemia

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29
Q

ischemia

A

an inadequate blood supply to an organ or part of the body causing pain

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30
Q

Smoking increases platelet aggregation leading to

A

clot formation

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31
Q

aggregation

A

clustering

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32
Q

Atherosclerosis clinical manifestations:

Coronary arteries

A

angina, MI

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33
Q

Atherosclerosis clinical manifestations:

Cerebral arteries

A

Stroke , TIA’s

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34
Q

Atherosclerosis clinical manifestations:

Aorta

A

aneurysm

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35
Q

Atherosclerosis of Extremities

A

Peripheral Artery Disease

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36
Q

Number 1 sign of Peripheral Artery Disease

A

Intermittent claudication

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37
Q

Pain caused by too little blood flow to muscles during exercise.

A

Claudication

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38
Q

What do the legs/feet look like with PAD?

A

Thin brittle shiny skin on legs/feet
Loss of hair on legs
Dependent rubor
Thickened toenails

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39
Q

What might you find while assessing legs/feet with PAD?

A

Diminished peripheral pulses
Prolonged capillary refill

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40
Q

Patients with advanced PAD will feel

A

Pain at rest

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41
Q

Patients with PAD may have what kind of ulcers?

A

dry, necrotic, delayed healing

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42
Q

Pain is distal to

A

diseased artery

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43
Q

Claudication may begin shortly after

A

activity begins

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44
Q

PAD:

Elevating legs makes pain _____ and foot becomes _____

A

worse and foot becomes pale

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45
Q

PAD:

Dangling (dependent) legs does what to pain? What color do the feet turn?

A

relieves pain – foot becomes deep red (rubor)

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46
Q

PAD:

Med that improves blood flow

A

Cilostazol

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47
Q

Onychomycosis is

A

A fungal infection of the nail

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48
Q

PAD diagnostic tests:

Sees blood flow in legs

A

Doppler study

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49
Q

PAD diagnostic tests:

Testing for claudication

A

Treadmill test

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50
Q

PAD diagnostic tests:

combines both ultrasound and Doppler procedures. The result is live, high-definition pictures of blood flow.

A

Duplex ultrasound

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51
Q

PAD diagnostic tests:

Non-invasive test performed by measuring the systolic blood pressure from both brachial arteries and from both the dorsalis pedis and posterior tibial arteries after the patient has been at rest in the supine position for 10 minutes

A

Arterial Brachial Index (ABI)

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52
Q

What patients need ABI?

A

Pt with diminished pulses
50 y or older with history of diabetes

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53
Q

Patients with an ABI <0.9 =

A

PAD

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54
Q

NORMAL ABI is

A

1 – 1.4

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55
Q

NORMAL ABI is because feet arterial BP

A

Is slightly higher than brachial

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56
Q

Cilostazol should enable pt to

A

walk longer periods of time without pain

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57
Q

Pt will aortoiliac disease –

A

assess femoral pulse

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58
Q

Carbon monoxide from tobacco binds to

A

hemoglobin depriving tissues of oxygen

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59
Q

Fluid exchange across capillary wall based on

A

hydrostatic and osmotic forces.

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60
Q

Hydrostatic pressure at arterial end is higher then

A

venous

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61
Q

Hydrostatic pressure at arterial end drives fluid into the

A

tissue space

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62
Q

At venous end of capillary, osmotic forces

A

reabsorb fluid back into capillary.

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63
Q

Any left over fluid goes into

A

lymphatic vessels

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64
Q

Interpretation of ABI:

> 1.30

A

Noncompressible

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65
Q

Interpretation of ABI:

0.41 - 0.90

A

Mid-Moderate PAD

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66
Q

Interpretation of ABI:

0.00 - 0.40

A

Severe PAD

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67
Q

PAD patient teaching

A

Promote exercise, dangle legs, do not elevated, no crossing legs, no heating pads
Weight reduction, smoking cessation, reduce BP

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68
Q

Platelet Inhibitors prevent

A

clots

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69
Q

Platelet Inhibitor med names

A

Aspirin
Clopidogrel (Plavix)
Cilostazol (Pletal)

70
Q

Statins draw

A

cholesterol out of plaques

71
Q

Endovascular Treatments

A

Balloon angioplasty, stent, atherectomy

72
Q

After graft/stent, patient will likely be placed on

A

platelet inhibitor to keep stent/graft open

73
Q

Surgery for partial and complete blockage

A

Bypass grafts

74
Q

Autologous bypass graft

A

pt’s own vein

75
Q

Dacron graft

A

Synthetic bypass graft

76
Q

Nursing care post bypass

A

VS & Pulse check q15 min initially
Incision site – monitor for hematoma
Neurovascular checks (cap refill/temperature/color)
Edema expected, elevate EXT while in bed and ambulate as soon as possible
No leg crossing or prolonged dependent position

77
Q

After fem-pop bypass – which pulse do you assess?

A

After fem-pop bypass, assess dorsalis pedis or tibial

78
Q

Checking for complications:

Graft Occlusion

A

pallor, decreased pulses, cool skin temperature

79
Q

Checking for complications:

Compartment Syndrome

A

Numbness, severe pain, edema, taunt skin

80
Q

If there are complications after treatment surgery

A

Ambulate ASAP

81
Q

Med given in recovery room

A

Plavix or may be kept on heparin drip

82
Q

Stenosis and occlusions less frequent in

83
Q

Upper extremity arterial disease is usually the result of

A

atherosclerosis or trauma

84
Q

S&S of Upper extremity arterial disease

A

Arm fatigue, pain with exercise, inability to hold objects
Cool, pales, decreased capillary refill

85
Q

Diagnostic test to determine upper extremity arterial disease

A

Doppler studies

86
Q

Artery providing blood flow to brain reverses to arm causing lightheadedness

A

Subclavian steal syndrome

87
Q

Treatment for upper extremity arterial disease

A

PTA with stent or graft

88
Q

PTA

A

Percutaneous Transluminal Angioplasty

89
Q

Nursing after surgery for upper extremity arterial disease

A

Vascular checks – if no pulse – immediately contact physician
Keep arm at heart level or elevated after surgery

90
Q

Aching/burning is ischemia, but a complete occlusion is

A

more severe pain, or complete loss of sensation

91
Q

6 P’s

A

Pain
Pallor
Pulselessness
Paresthesia
Poikilothermia
Paralysis

92
Q

Poikilothermia

A

the inability to regulate core body temperature

93
Q

Parasthesia

A

Pins and needles

94
Q

COLD / PALE FOOT – will turn

95
Q

Balloon tipped catheter that removes embolus

A

Emergency embolectomy

96
Q

If patient has adequate collateral circulation

A

Heparin or t-PA is given

97
Q

t-PA :

A

tissue plasminogen activator (clot buster), an injection given right into clot

98
Q

Arterial occlusions are diagnosed with

A

ultrasound and arteriogram

99
Q

Nursing Management of arterial occlusion:

Prior to intervention:

A

BEDREST
Affected EXT level or slightly dependent
Keep EXT room temperature (no heating/cooling pads)

100
Q

Nursing Management of arterial occlusion:

Med stopped 30 minutes prior to surgery

A

IV Heparin

101
Q

Intermittent arteriolar vasoconstriction
Results in coldness/pallor/pain of fingertips, toes

A

Raynaud’s phenomenon

102
Q

Reynaud’s:

Rebound circulation causes

A

redness and pain

103
Q

Skin color changes associated with Raynaud’s

A

WHITE – then BLUE because of pooling of deoxygenated blood the RED from exaggerated blood flow during vasodilation

104
Q

Raynaud’s phenomenon stimulus:

A

Cold, Stress, Nicotine

105
Q

Raynaud’s phenomenon Treatment:

A

usually none required, possible Calcium Channel Blocker

106
Q

idiopathic

A

no other condition (genetic)

107
Q

Veins that lie just under the skin

A

Superficial Veins

108
Q

Veins that run parallel to arteries

A

Deep Veins

109
Q

Venous disorders cause

A

reduction in venous blood flow back up to heart

110
Q

Result of Venous disorders

A

stasis of blood, edema, tissue breakdown (ulcers/cellulitis), increased susceptibility to cellulitis

111
Q

Small vessels rupture from pressure, rbc’s escape into surrounding tissue

A

Hemosiderin

112
Q

Chronic distension from increased pressure and incompetent valves

A

Chronic Venous insufficiency

113
Q

Risk factors for Chronic Venous insufficiency:

A

Obesity, immobility, pregnancy, history of DVT

114
Q

S&S of Chronic venous insufficiency:

A

edema, discolored skin – hemosiderin, draining wounds

115
Q

Treatment for Chronic Venous insufficiency:

A

Elevate legs
Compression stockings
Monitor for complications (cellulitis/wounds)

116
Q

S&S of Venous insufficiency

A

Varicose veins
Darkened, hard, leathery skin
Pain and heaviness
Restless leg syndrome
leg cramps or spasms (NOT intermittent claudication)
Itchy skin
Yellow toenails

117
Q

Virchow Triad

A

1) Hypercoagulability
2) Stasis
3) Vascular injury

118
Q

VTE

A

Venous thromboembolism

119
Q

Hypercoagulability state

A

Clotting too much

120
Q

Most common cause of this VTE factor:

Cancer malignancy
pregnancy and peri-partum (because of hormones)
Oestrogen therapy
Trauma or surgery of lower half of body

A

Hypercoagulability state

121
Q

Venous wall gets nicked or damaged

A

Vascular wall injury

122
Q

Most common cause of this VTE factor:

Trauma/injury
Venipuncture
Chemical irritation
Heart valve disease or replacement
Atherosclerosis
Indwelling catheters

A

Vascular wall injury

123
Q

When blood is not moving

A

Circulatory stasis

124
Q

Most common cause of this VTE factor:

Atrial fibrillation
Left ventricular dysfunction
Venous insufficiency or varicose veins
Venous obstruction from tumor
Obesity or pregnancy
Bedrest
Post op

A

Circulatory stasis

125
Q

Aggregates of platelets within the vein, attached to wall
More common in lower EXT’s

A

Deep vein thrombosis

126
Q

The 3 causes of deep vein thrombosis:

A

vein injury (phlebitis from IV/chemo),
stasis
hypercoagulability

127
Q

Clinical Manifestations of deep vein thrombosis:

A

Unilateral swelling of effected leg
Deep vein: edema, swelling, warmth, tenderness, red, concern of PE
Superficial veins: similar, usually dissolve spontaneously
Homan’s sign

128
Q

Treatments for deep vein thrombosis

A

Anticoagulant therapy (monitor labs to direct)
elevate legs - pillow under legs not knee
compression stocking
Thrombectomy – mechanical clot removal with balloon stent

129
Q

Once anticoagulation therapy started –

A

ambulate as soon as possible

130
Q

Diagnosing DVT

A

Blood work (coagulation studies),D dimer, duplex ultrasound

131
Q

Obstruction of pulmonary artery or one of its branches by a thrombus that originated in VENOUS system OR right side of heart

A

Pulmonary embolism (PE)

132
Q

Symptoms of PE depend on

A

size of thrombus and area of pulmonary artery occluded

133
Q

Symptoms of PE:

A

DYSPNEA
Chest pain, anxiety, tachycardia, dry cough

134
Q

Diagnosing PE :

A

CT Angiogram or V/Q SCAN

135
Q

Medical management of a stable patient with PE:

A

Lovenox/heparin

136
Q

Medical management of an unstable patient with PE:

A

Thrombolytic therapy
Embolectomy – Interventional radiology

137
Q

PE is not a ventilation problem, it is a

A

Perfusion problem

138
Q

Most dangerous form of PE

139
Q

Nursing care of patient with PE

A

Monitoring thrombolytic therapy
Bleeding precautions
Manage Pain
Manage oxygen therapy
Relieve anxiety
Education : Patient will be discharged on long term anticoagulation
IVC filter placement (in groin) before discharge

140
Q

IVC (inferior vena cava) filter does what? For how long?

A

Catches clots. Left in for one year

141
Q

Platelet inhibitors & Anticoagulants does what to clots?

A

slow, stop, prevent clot. DOES NOT BREAK

142
Q

Names of platelet inhibitors :

A

acetylsalicylic acid (Aspirin)
clopidogrel (Plavix)
cilostazol (Pletal)

143
Q

Anticoagulant PO med that blocks liver’s use of vit K to produce clotting factors. Takes up to 72 hours to work
No precise antidote, but can give VIT K

A

Warfarin (Coumadin)

144
Q

Newer PO anticoagulant meds:

no specific blood tests to monitor
No specific antidote exists
Can not stop taking suddenly

A

Dabigatran (Pradaxa)
Rivaroxaban (Xarelto)
Apixaban (ELIQUIS) PO only

145
Q

INR

A

International Normalized Ratio

146
Q

Foods that should be reduced/ eaten in moderation while taking warfarin (coumadin)

A

Green, leafy vegs

147
Q

Give more coumadin when INR is

148
Q

Give less coumadin when INR is

149
Q

Normal INR is

A

between 2-3

150
Q

Injectable anticoagulants that act rapidly to block formation of thrombin from prothrombin

A

Enoxaparin (Lovenox) (SQ)
Heparin (IV or SQ prophylactic)

151
Q

Rate of heparin determined protocol –

A

aPTT lab values should be higher that normal with heparin(1.5 – 2.5 times normal Aptt = 60-80)

152
Q

Will continue use of Heparin while starting Warfarin until

153
Q

Antidote to Heparin :

A

protamine sulfate

154
Q

Lovenox can be used for DVT, post operative, what type of surgery?

A

ortho surgery

155
Q

All patients on heparin:

A

Bleeding precautions
all stool is tested for blood (guaiac)
CBC is usually daily – not every 3 days

156
Q

HIT

A

Heparin induced thrombocytopenia

157
Q

Low platelet count due to heparin

A

HIT - Heparin induced thrombocytopenia

158
Q

Abnormally dilated, tortuous veins
Incompetent valves

A

Varicose veins

159
Q

Clinical Manifestations of varicose veins:

A

Asymptomatic if superficial
Deep veins – dull ache, cramps heaviness, fatigue, swelling

160
Q

Nonsurgical treatments for varicose veins:

A

Thermal Ablation, sclerotherapy, laser

161
Q

Surgical treatments for varicose veins:

A

Ligation and stripping – vein is pulled out with the metal wire

162
Q

Compression therapy is mostly done with what type of ulcer?

A

venous ulcers

163
Q

Mechanical debridement –

A

wet-to-dry dressings

164
Q

Autolytic debridement –

A

application of dressings that allow lysozymes in wound exudate to naturally breakdown nonviable tissue – Aquacel

165
Q

Autolytic debridement med

166
Q

Aquacel holds a lot of

167
Q

Chemical debridement med

A

Santyl (collagenase)

168
Q

Ulcer treatments

A

Antiseptic agents
Antibiotics
Debridement
hyperbaric oxygenation
wound vac

169
Q

What kind of diet is appropriate for a patient with leg ulcers?

A

High protein diet rich in vitamins

170
Q

Condition where the Microbes enter skin via entry point,
Toxins released into subcutaneous tissues, causing Swelling, redness, warmth and pain

A

Cellulitis

Med/Surg (17 decks)

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